Attempts to avert HIV are off target

Risky sexual behaviour is continuing around the globe and even increasing in some countries, threatening to derail efforts to stop transmission of the HIV virus and bring the Aids epidemic to an end, according to an authoritative United Nations report.

Although drug treatment for people with HIV is saving millions of lives and deaths are falling, the prospects for stopping the spread of infection are not promising, said UNAids in its annual report ahead of World Aids Day on December 1. The target of halving new sexually acquired infections in the next three years looks ambitious.

"Getting to zero new HIV infections will require substantial reductions each year in sexual HIV transmission, which accounts for the overwhelming majority of the people who are newly infected," said the report.
"The current pace of progress is insufficient to reach the global goal of halving sexual transmission by 2015, underscoring the urgent need for intensified action."

Attempts to educate people about safe sex and persuade them of the wisdom of having fewer sexual partners and of using condoms have had some success in certain hard-hit countries, such as Kenya, Malawi, Mozambique, Namibia, Nigeria and Zambia. But in spite of the dangers, risk-taking has increased in others – notably in Côte d'Ivoire, Guyana and Rwanda. Rwanda reports an increase in boys having sex under the age of 15 and of both men and women having multiple partners. In Côte d'Ivoire, Uganda, Benin and Burkina Faso, condom use has declined.

In 26 of the 31 countries with what are called generalised epidemics, less than half of young women have a proper understanding of HIV and do not know that condoms can protect them. In 21 of those countries, young men are also ignorant of the facts.

Future consequences
Trying to encourage people to change their behaviour is a complicated and difficult business, the report acknowledges. "It involves knowledge, motivations and choices, which are influenced by sociocultural norms, as well as risk assessment in relation to immediate benefits and future consequences. It involves both rational decision-making and impulsive and automatic behaviour," said the report.

It also needs money. The report said only 5% of HIV funding in the worst-hit countries went on behaviour change programmes, including condom promotion.

Condoms are also not sufficiently available. "The UN Population Fund estimates that only nine donor-provided male condoms were available for every man aged 15 to 49 years in sub-Saharan Africa in 2011, and one female condom for every 10 women aged 15 to 49 years," said the report.

Stopping the birth of babies infected with HIV through drug treatment for their mothers in pregnancy is a major target for Aids prevention. About 409000 children have been saved from infection between 2009 and 2011. But last year 330 000 babies were born with the virus ­– more than 90% of them in sub-Saharan Africa. In four countries – Angola, the Democratic Republic of Congo, Equatorial Guinea and Guinea-Bissau – the number of HIV-positive babies born actually increased. One of the problems is that breast-feeding women in some regions are not given antiretroviral drugs, which helps to safeguard the baby as well as themselves. The report also notes there has been little improvement in the availability of contraception for women who do not want to have another child.

Prevention programmes for groups of people who are at particular risk, such as sex workers, drug users and men who have sex with men, are far too limited, the report said.

The report testifies to the massive achievements made over the years in reducing deaths and infections. "Although Aids remains one of the world's most serious health challenges, global solidarity in the Aids response during the past decade continues to generate extraordinary health gains," it said.

New infections
There are now 34-million people globally living with HIV – a figure that is rising as drug treatment keeps more people alive. In sub-Saharan Africa, still the worst-affected region, nearly one in five adults is living with HIV.

Global infection rates are coming down. Last year, 2.5-million people were infected – a drop of 20% on the number of new infections in 2001. The numbers have dropped most sharply in the Caribbean and sub-Saharan Africa.

"In some other parts of the world, HIV trends [for children and adults] are cause for concern. Since 2001, the number of people newly infected in the Middle East and North Africa has increased by more than 35% (from 27000 to 37000). Evidence indicates that the incidence of HIV infection in Eastern Europe and Central Asia began increasing in the late 2000s after having remained relatively stable for several years," said the report.

In at least nine countries – Bangladesh, Georgia, Guinea-Bissau, Indonesia, Kazakhstan, Kyrgyzstan, the Philippines, Moldova and Sri Lanka – the number of people newly infected last year was at least 25% higher than in 2001.